2021; Volume 22, No 7, July
IAHPC Research Advisor Dr. Tania Pastrana selects one article from recently published medical literature and describes why it is worthwhile.
Under My Microscope
Dr. Tania Pastrana. Used with permission.
By Dr. Tania Pastrana
IAHPC Research Advisor
Cancer Cachexia in Adult Patients: ESMO Clinical Practice Guidelines
Arends J, Strasser F, Gonella S, Solheim TS, Madeddu C, Ravasco P, et aI. ESMO Open 2021; 6(3). DOI: 10.1016/j.esmoop.2021.100092
Cachexia, a disorder that causes extreme weight loss and muscle wasting, is a frequent and devastating syndrome in patients suffering from advanced cancer. Though often taken for granted and underdiagnosed, cachexia often spurs desperate attempts by some to “pump up” patients in palliative care wards with hypercaloric parenteral feeding. I remember Eduardo Bruera’s words: When the oven is damaged, you can add all the flour you want, but you will not end up with baked bread.
This interesting condition intertwines physiological, psychological, and even social and existential dimensions that have a high impact on patients and their careers. In palliative care, this complexity is typical.
The ESMO Guidelines Committee developed these guidelines for medical oncologists, based on available scientific data and the author's expert opinion, but they are highly relevant for palliative care. The guidelines comprise an updated and comprehensive review, including definition, assessment, and treatment of cachexia, highlighting the integration of palliative care in the “inner circle” of a cachexia clinic or team.
I hope that these new guidelines will help guide decision-makers in the rational use of parenteral nutrition. When used without medical need, the practice improved neither health-related quality of life nor survival and induced more serious adverse events than oral feeding only among patients with advanced cancer and malnutrition.”1
Reference
1. Bouleuc C, Anota A, Cornet C, Grodard G, Thiery-Vuillemin A, Dubroeucq O, et al. Impact on Health Related Quality of Life of Parenteral Nutrition for Patients with Advanced Cancer Cachexia: Results from a Randomized Controlled Trial. Oncologist 2020; 25(5): e843-e851. DOI: 10.1634/theoncologist.2019-0856
Read Tania Pastrana’s bio here.
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Media Watch: At-home care
The articles below are selected from recent issues of Barry R. Ashpole’s weekly report, Media Watch.
Development of the Readiness for Home-Based Palliative Care Scale for Primary Family Caregivers
Healthcare | Online – 19 May 2021 – A measurement of the readiness for home-based palliative care for primary family caregivers is needed in Eastern society, as many choose to die at home but caregivers are unprepared. This study recruited 103 participants from five branches of one municipal hospital system in Taiwan. The reliability and validity of the Readiness for Home-Based Palliative Care Scale was evaluated and proven to have strong goodness-of-fit and good reliability and validity. DOI: 10.3390/healthcare9050608
Delivering End‐of‐Life Care for Patients with Cancer at Home: Interviews exploring the views and experiences of general practitioners
Health & Social Care in the Community | Online – Five main themes were constructed: 1) the subjective nature of defining palliative and end-of-life care (EoLC), 2) importance of communication and managing expectations, 3) complexity in prescribing, 4) challenging nature of delivering EoLC, and 5) the unclear role of primary care in palliative care. These challenges, coupled with a poorly defined role, create a spread in perceived confidence. Experience and exposure were seen as enabling confidence. Specialist PC service expansion had important implications on deskilling of essential competencies and reducing confidence levels in general GPs. DOI: 10.1111/hsc.13419
Effectiveness of a Family-Caregiver Training Program in Home-Based Pediatric Palliative Care
Children | Online – 26 February 2021 – This study shows that a provided intervention had a particularly positive effect in caretakers’ self-perception and confidence about the outstanding caring skills they already had. Although the number of out-of-hours telephone calls from the caregivers to the pediatric palliative care (PC) team after the intervention did not decrease, they were more focused on the description of symptoms. Psycho-educational space emerged in the authors’ school for parents of children with complex health care needs in the setting of home-based PC that allowed them to share their experience of daily care for their children. DOI: 10.3390/children8030178
Stakeholder-Engaged Process for Refining the Design of a Clinical Trial in Home Hospice
BMC Medical Research Methodology | Online – 30 April 2021 – Clinical trials in home hospice settings are important but challenging. This study describes a stakeholder-engaged process to refine, design, and implement aspects of an educational intervention in home hospice, including recommendations for refining intervention content and delivery, recruitment and enrollment strategies and content and frequency of outcome measurement. DOI: 10.1186/s12874-021-01275-0
Media Watch monitors the literature and the lay press on issues specific to the quality of end-of-life care. It is international in scope and distribution. View current and back issues here.